Location Matters in Statin Treatment Among Veterans with Type 2 Diabetes

Patients with diabetes are more likely to develop cardiovascular disease and events than patients without diabetes. Statin therapy is known to reduce the risk of cardiovascular events, and guidelines recommend them in all patients with diabetes.¹ Despite this, several studies have documented racial and ethnic disparities in statin use.

A recent study in the American Journal of Cardiology delved deeper into the subject to determine the joint impact of race and location of residence on statin use among veterans.²

The study found that non-Hispanic black veterans were 14% less likely to be on a statin than white urban veterans. Hispanic urban veterans, on the other hand, were 20% more likely to be on a statin than white urban veterans. White and non-Hispanic black veterans who lived in rural areas were about 5-7% more likely to receive a statin, while rural Hispanic veterans were 10% less likely to receive a statin.

These results provide evidence that both race and location of residence affect statin prescribing. Black veterans received less statin treatment than white veterans. Black and white veterans were less likely to receive statin treatment in urban areas than in rural areas, while in Hispanic veterans it was the reverse. It appears that access to care based on location is different across different racial/ethnic groups.

This study also found that access to Veterans Health Administration (VHA) care improved rates of statin therapy across all groups. It found that patients with disabilities and with dual use care (both VHA care and private insurance) had better rates of statin use, especially among minority veterans. The researchers suggest that disability qualifies patients for more care, leading to this improvement.

These findings suggest that access to low cost or free medications increases statin use among veterans. Increasing access to VHA services among veterans in the future may improve statin use and associated health-care outcomes.

Ivan Navarro is a 2020 PharmD candidate at the University of Connecticut in Storrs.

REFERENCES

• Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019;73:3168—3209.
• Weeda ER, Bishu KG, Ward RC, et al. Impact of Race and Location of Residence on Statin Treatment Among Veterans With Type 2 Diabetes Mellitus. Am J Cardiol. 2020. doi:10.1016/j.amjcard.2020.02.027.